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Ning X, Li L, Liu J, Wang F, Tan K, Li W, Zhou K, Jing S, Lin A, Bi J, Zhao S, Deng H, Zhu C, Lv S, Li J, Liang J, Zhao Q, Wang Y, Chen B, Zhu L, Shen G, Liu J, Li Z, Deng J, Zhao X, Shan M, Wang Y, Liu S, Jiang T, Chen X, Zhang Y, Cai S, Wang L, Lu X, Jiang J, Dong F, Ye L, Sun J, Yao K, Yang Y, Liu G. Invasive pneumococcal diseases in Chinese children: a multicentre hospital-based active surveillance from 2019 to 2021. Emerg Microbes Infect 2024; 13:2332670. [PMID: 38646911 PMCID: PMC11047219 DOI: 10.1080/22221751.2024.2332670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/15/2024] [Indexed: 04/23/2024]
Abstract
This study aimed to provide data for the clinical features of invasive pneumococcal disease (IPD) and the molecular characteristics of Streptococcus pneumoniae isolates from paediatric patients in China. We conducted a multi-centre prospective study for IPD in 19 hospitals across China from January 2019 to December 2021. Data of demographic characteristics, risk factors for IPD, death, and disability was collected and analysed. Serotypes, antibiotic susceptibility, and multi-locus sequence typing (MLST) of pneumococcal isolates were also detected. A total of 478 IPD cases and 355 pneumococcal isolates were enrolled. Among the patients, 260 were male, and the median age was 35 months (interquartile range, 12-46 months). Septicaemia (37.7%), meningitis (32.4%), and pneumonia (27.8%) were common disease types, and 46 (9.6%) patients died from IPD. Thirty-four serotypes were detected, 19F (24.2%), 14 (17.7%), 23F (14.9%), 6B (10.4%) and 19A (9.6%) were common serotypes. Pneumococcal isolates were highly resistant to macrolides (98.3%), tetracycline (94.1%), and trimethoprim/sulfamethoxazole (70.7%). Non-sensitive rates of penicillin were 6.2% and 83.3% in non-meningitis and meningitis isolates. 19F-ST271, 19A-ST320 and 14-ST876 showed high resistance to antibiotics. This multi-centre study reports the clinical features of IPD and demonstrates serotype distribution and antibiotic resistance of pneumococcal isolates in Chinese children. There exists the potential to reduce IPD by improved uptake of pneumococcal vaccination, and continued surveillance is warranted.
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Affiliation(s)
- Xue Ning
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Lianmei Li
- Department of Infectious and Digestive Diseases, Qinghai Province Women and Children's Hospital, Xining, People’s Republic of China
| | - Jing Liu
- Department of Infectious Diseases, Hunan Children’s Hospital, Changsha, People’s Republic of China
| | - Fang Wang
- Department of Infectious Diseases, Henan Children’s Hospital, (Children's Hospital Affiliated of Zhengzhou University, Zhengzhou Children's Hospital), Zhengzhou, People’s Republic of China
| | - Kun Tan
- Department of Infectious Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Wenhui Li
- Department of Infectious and Digestive Diseases, Children’s Hospital of Hebei Province, Shijiazhuang, People’s Republic of China
| | - Kai Zhou
- Department of Infectious Diseases, Children’s Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Shujun Jing
- Department of Infectious Diseases, Dalian Children’s Hospital, Dalian, People’s Republic of China
| | - Aiwei Lin
- Department of Infectious Diseases, Children’s Hospital Affiliated to Shandong University, Jinan, People’s Republic of China
- Jinan Children’s Hospital, Shandong University, Jinan, People’s Republic of China
| | - Jing Bi
- Department of Infectious Diseases, Baoding Children’s Hospital, Baoding, People’s Republic of China
| | - Shiyong Zhao
- Department of Infectious Diseases, Hangzhou Children’s Hospital, Hangzhou, People’s Republic of China
| | - Huiling Deng
- Department of Infectious Diseases, Xian Children’s Hospital, Xian, People’s Republic of China
| | - Chunhui Zhu
- Department of Infectious Diseases, Children’s Hospital of Jiangxi Province, Nanchang, People’s Republic of China
| | - Shanshan Lv
- Department of Infectious Diseases, Changchun Children’s Hospital, Changchun, People’s Republic of China
| | - Juan Li
- Department of Infectious Diseases, Urumqi Children’s Hospital, Urumqi, People’s Republic of China
| | - Jun Liang
- Department of Pediatric Intensive Care Unit, People’s Hospital of Liaocheng, Liaocheng, People’s Republic of China
| | - Qing Zhao
- Department of Infectious Diseases, Children’s Hospital of Shanxi Province, Taiyuan, People’s Republic of China
| | - Yumin Wang
- Department of Infectious Diseases, Maternal and Child Health Care Hospital of the Inner Mongolia autonomous region, Huhehaote, People’s Republic of China
| | - Biquan Chen
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, People’s Republic of China
| | - Liang Zhu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guowu Shen
- Department of clinical laboratory, Qinghai Province Women and Children's Hospital, Xining, People’s Republic of China
| | - Jianlong Liu
- Department of clinic laboratory, Hunan Children’s Hospital, Changsha, People’s Republic of China
| | - Zhi Li
- Department of Infectious Diseases, Henan Children’s Hospital, (Children's Hospital Affiliated of Zhengzhou University, Zhengzhou Children's Hospital), Zhengzhou, People’s Republic of China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Xin Zhao
- Department of Infectious and Digestive Diseases, Children’s Hospital of Hebei Province, Shijiazhuang, People’s Republic of China
| | - Mingfeng Shan
- Department of Infectious Diseases, Children’s Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yi Wang
- Department of Infectious Diseases, Dalian Children’s Hospital, Dalian, People’s Republic of China
| | - Shihua Liu
- Department of Infectious Diseases, Children’s Hospital Affiliated to Shandong University, Jinan, People’s Republic of China
- Jinan Children’s Hospital, Shandong University, Jinan, People’s Republic of China
| | - Tingting Jiang
- Department of Infectious Diseases, Baoding Children’s Hospital, Baoding, People’s Republic of China
| | - Xuexia Chen
- Department of Infectious Diseases, Hangzhou Children’s Hospital, Hangzhou, People’s Republic of China
| | - Yufeng Zhang
- Department of Infectious Diseases, Xian Children’s Hospital, Xian, People’s Republic of China
| | - Sha Cai
- Department of Infectious Diseases, Children’s Hospital of Jiangxi Province, Nanchang, People’s Republic of China
| | - Lixue Wang
- Department of Infectious Diseases, Changchun Children’s Hospital, Changchun, People’s Republic of China
| | - Xudong Lu
- Department of Infectious Diseases, Urumqi Children’s Hospital, Urumqi, People’s Republic of China
| | - Jinghui Jiang
- Department of Pediatric Intensive Care Unit, People’s Hospital of Liaocheng, Liaocheng, People’s Republic of China
| | - Fang Dong
- Department of Infectious Diseases, Children’s Hospital of Shanxi Province, Taiyuan, People’s Republic of China
| | - Lan Ye
- Department of Infectious Diseases, Maternal and Child Health Care Hospital of the Inner Mongolia autonomous region, Huhehaote, People’s Republic of China
| | - Jing Sun
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, People’s Republic of China
| | - Kaihu Yao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, People’s Republic of China
| | - Yonghong Yang
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, People’s Republic of China
| | - Gang Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, People’s Republic of China
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Olarte L, Banerjee D, Swanson D, Tabakh J, Lee B, Harrison CJ, Selvarangan R. Pneumococcal Colonization in Children With Persistent Asthma: A Retrospective Cohort. Pediatr Infect Dis J 2024:00006454-990000000-00900. [PMID: 38900076 DOI: 10.1097/inf.0000000000004438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Asthma is the most common chronic medical condition among children ≥5 years of age with invasive pneumococcal disease. How asthma or its management affects pneumococcal colonization is not fully understood. Our objective was to compare pneumococcal colonization rates between children with persistent asthma and children without asthma, and to characterize the pneumococcal serotype distribution. METHODS We used nasal mid-turbinate samples obtained per routine care from 5- to 18-year-old children with upper respiratory symptoms from November to April (respiratory seasons) of 2017 to 2018 and 2018 to 2019 in Kansas City, United States. Pneumococcal immunization status, prior antibiotic use and other clinical data were collected. Samples were tested for pneumococcal colonization by real-time polymerase chain reaction targeting lytA gene. Positive samples underwent multiplex serotype-specific polymerase chain reaction assays to determine the serotype. RESULTS Of 363 children (120 with persistent asthma and 243 without asthma), 87.6% were 5 to 10 years old, 50.1% were female and 74.1% received ≥3 doses of a pneumococcal conjugate vaccine. The pneumococcal colonization rate was lower in children with persistent asthma than in children without asthma (10% versus 18.9%, P = 0.03). The odds of colonization were lower in children with persistent asthma [OR 0.4 (95% confidence interval: 0.2-0.9)] after adjusting for demographic and clinical data. Pneumococcal serotype was confirmed in 77.6% of positive samples; 35.6% of those samples corresponded to PCV13 serotypes and 64.4% to non-PCV13 serotypes. The most common serotypes were 19F (15%), 3 (13%) and 6C/6D (11%). CONCLUSIONS Children with persistent asthma had lower rates of pneumococcal colonization than children without asthma when seeking care for respiratory symptoms.
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Affiliation(s)
- Liset Olarte
- From the Department of Pediatrics, Children's Mercy Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Missouri
| | - Dithi Banerjee
- University of Missouri-Kansas City School of Medicine, Missouri
- Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Missouri
| | - Douglas Swanson
- From the Department of Pediatrics, Children's Mercy Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Missouri
| | - Jennifer Tabakh
- From the Department of Pediatrics, Children's Mercy Kansas City, Missouri
| | - Brian Lee
- From the Department of Pediatrics, Children's Mercy Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Missouri
| | - Christopher J Harrison
- From the Department of Pediatrics, Children's Mercy Kansas City, Missouri
- University of Missouri-Kansas City School of Medicine, Missouri
| | - Rangaraj Selvarangan
- University of Missouri-Kansas City School of Medicine, Missouri
- Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Missouri
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Qiu X, McGee L, Hammitt LL, Grant LR, O’Brien KL, Hanage WP, Lipsitch M. Prediction of post-PCV13 pneumococcal evolution using invasive disease data enhanced by inverse-invasiveness weighting. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.10.23299786. [PMID: 38168234 PMCID: PMC10760274 DOI: 10.1101/2023.12.10.23299786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background After introduction of pneumococcal conjugate vaccines (PCVs), serotype replacement occurred in the population of Streptococcus pneumoniae. Predicting which pneumococcal clones and serotypes will become more common in carriage after vaccination can enhance vaccine design and public health interventions, while also improving our understanding of pneumococcal evolution. We sought to use invasive disease data to assess how well negative frequency-dependent selection (NFDS) models could explain pneumococcal carriage population evolution in the post-PCV13 epoch by weighting invasive data to approximate strain proportions in the carriage population. Methods Invasive pneumococcal isolates were collected and sequenced during 1998-2018 by the Active Bacterial Core surveillance (ABCs) from the Centers for Disease Control and Prevention (CDC). To predict the post-PCV13 population dynamics in the carriage population using a NFDS model, all genomic data were processed under a bioinformatic pipeline of assembly, annotation, and pangenome analysis to define genetically similar sequence clusters (i.e., strains) and a set of accessory genes present in 5% to 95% of the isolates. The NFDS model predicted the strain proportion by calculating the post-vaccine strain composition in the weighted invasive disease population that would best match pre-vaccine accessory gene frequencies. To overcome the biases of invasive disease data, serotype-specific inverse-invasiveness weights were defined as the ratio of the proportion of the serotype in the carriage data to the proportion in the invasive data, using data from 1998-2001 in the United States, before conjugate vaccine introduction. The weights were applied to adjust both the observed strain proportion and the accessory gene frequencies. Results Inverse-invasiveness weighting increased the correlation of accessory gene frequencies between invasive and carriage data with reduced residuals in linear or logit scale for pre-vaccine, post-PCV7, and post-PCV13. Similarly, weighting increased the correlation of accessory gene frequencies between different time periods in the invasive data. By weighting the invasive data, we were able to use the NFDS model to predict strain proportions in the carriage population in the post-PCV13 epoch, with the adjusted R-squared between predicted and observed strain proportions increasing from 0.176 to 0.544 after weighting. Conclusions The weighting system adjusted the invasive disease surveillance data to better represent the carriage population of S. pneumoniae. The NFDS mechanism predicted the strain proportions in the projected carriage population as estimated from the weighted invasive disease frequencies in the post-PCV13 epoch. Our methods enrich the value of genomic sequences from invasive disease surveillance, which is readily available, easy to collect, and of direct interest to public health.
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Affiliation(s)
- Xueting Qiu
- Center for Communicable Disease Dynamics, Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Lesley McGee
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura L Hammitt
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lindsay R Grant
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine L O’Brien
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Feemster K, Weaver J, Buchwald U, Banniettis N, Cox KS, McIntosh ED, Spoulou V. Pneumococcal Vaccine Breakthrough and Failure in Infants and Children: A Narrative Review. Vaccines (Basel) 2023; 11:1750. [PMID: 38140155 PMCID: PMC10747311 DOI: 10.3390/vaccines11121750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Globally, Streptococcus pneumoniae is a leading cause of vaccine-preventable morbidity and mortality in infants and children. In recent decades, large-scale pediatric immunization programs have substantially reduced the incidence of invasive pneumococcal disease. Despite this, residual vaccine-type pneumococcal disease remains in the form of vaccine breakthrough and vaccine failure. This targeted literature review aims to discuss aspects of vaccine breakthrough and failure in infants and children, including disease epidemiology, clinical presentation, risk factors, vaccination schedules, vaccine serotypes, correlates of protection, comorbidities, disease surveillance, and potential implications for future vaccine development.
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Affiliation(s)
- Kristen Feemster
- Merck & Co., Inc., Rahway, NJ 07065, USA; (J.W.); (U.B.); (N.B.); (K.S.C.)
| | - Jessica Weaver
- Merck & Co., Inc., Rahway, NJ 07065, USA; (J.W.); (U.B.); (N.B.); (K.S.C.)
| | - Ulrike Buchwald
- Merck & Co., Inc., Rahway, NJ 07065, USA; (J.W.); (U.B.); (N.B.); (K.S.C.)
| | - Natalie Banniettis
- Merck & Co., Inc., Rahway, NJ 07065, USA; (J.W.); (U.B.); (N.B.); (K.S.C.)
| | - Kara S. Cox
- Merck & Co., Inc., Rahway, NJ 07065, USA; (J.W.); (U.B.); (N.B.); (K.S.C.)
| | | | - Vana Spoulou
- Immunobiology and Vaccinology Research Laboratory, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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Phuong LK, Cheung A, Agrawal R, Butters C, Buttery J, Clark J, Connell T, Curtis N, Daley AJ, Dobinson HC, Frith C, Hameed NS, Hernstadt H, Krieser DM, Loke P, Ojaimi S, McMullan B, Pinzon-Charry A, Sharp EG, Sinnappurajar P, Templeton T, Wen S, Cole T, Gwee A. Inborn Errors of Immunity in Children With Invasive Pneumococcal Disease: A Multicenter Prospective Study. Pediatr Infect Dis J 2023; 42:908-913. [PMID: 37463351 DOI: 10.1097/inf.0000000000004004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND In settings with universal conjugate pneumococcal vaccination, invasive pneumococcal disease (IPD) can be a marker of an underlying inborn error of immunity. The aim of this study was to determine the prevalence and characterize the types of immunodeficiencies in children presenting with IPD. METHODS Multicenter prospective audit following the introduction of routinely recommended immunological screening in children presenting with IPD. The minimum immunological evaluation comprised a full blood examination and film, serum immunoglobulins (IgG, IgA and IgM), complement levels and function. Included participants were children in whom Streptococcus pneumoniae was isolated from a normally sterile site (cerebrospinal fluid, pleura, peritoneum and synovium). If isolated from blood, features of sepsis needed to be present. Children with predisposing factors for IPD (nephrotic syndrome, anatomical defect or malignancy) were excluded. RESULTS Overall, there were 379 episodes of IPD of which 313 (83%) were eligible for inclusion and 143/313 (46%) had an immunologic evaluation. Of these, 17/143 (12%) were diagnosed with a clinically significant abnormality: hypogammaglobulinemia (n = 4), IgA deficiency (n = 3), common variable immunodeficiency (n = 2), asplenia (n = 2), specific antibody deficiency (n = 2), incontinentia pigmenti with immunologic dysfunction (n = 1), alternative complement deficiency (n = 1), complement factor H deficiency (n = 1) and congenital disorder of glycosylation (n = 1). The number needed to investigate to identify 1 child presenting with IPD with an immunologic abnormality was 7 for children under 2 years and 9 for those 2 years old and over. CONCLUSIONS This study supports the routine immune evaluation of children presenting with IPD of any age, with consideration of referral to a pediatric immunologist.
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Affiliation(s)
- Linny Kimly Phuong
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Abigail Cheung
- Department of Allergy and Clinical Immunology, Women's and Children's Hospital, South Australia
- General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, New Lambton, Australia
| | - Rishi Agrawal
- Department of General Medicine, Women's and Children's Hospital, South Australia
| | - Coen Butters
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, New Lambton, Australia
| | - Jim Buttery
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Julia Clark
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Tom Connell
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew J Daley
- Department of Microbiology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Hazel C Dobinson
- Department of Paediatrics and Child Health, Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Catherine Frith
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | | | - Hayley Hernstadt
- Department of Paediatrics, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia
| | - David M Krieser
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatric Emergency Medicine, Sunshine Hospital, St Albans, Victoria, Australia
| | - Paxton Loke
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Allergy & Immunology, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Pathology, Monash Health; Clayton, Victoria, Australia
| | - Samar Ojaimi
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Allergy & Immunology, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Pathology, Monash Health; Clayton, Victoria, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | - Alberto Pinzon-Charry
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Immunology & Allergy Service, Queensland Children's Hospital, Queensland, Australia
- Griffith University, Brisbane, Queensland, Australia
| | - Ella Grace Sharp
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | | | - Tiarni Templeton
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Sophie Wen
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Theresa Cole
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Gwee
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Accardi KT, Bocchini JA. Control and Prevention of Invasive Pneumococcal Disease: A Current and Historical Perspective. Pediatr Ann 2023; 52:e96-e101. [PMID: 36881796 DOI: 10.3928/19382359-20230118-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Although significant progress has been made in reducing the incidence of invasive pneumococcal disease (IPD) in children, IPD remains a continued threat. Since the introduction of pneumococcal conjugate vaccines (PCVs), rates of IPD and non-IPD have substantially decreased. However, serotype replacement reversed some of the benefits of PCV7 and, more recently, PCV13. Several replacement serotypes are antibiotic resistant, which is a cause of concern for providers. The introduction of the higher-valency conjugate vaccines PCV15 and PCV20 is expected to provide greater serotype coverage; unfortunately, these vaccines do not include some of the recently emerged serotypes. Recommendations for the use of the 23-valent polysaccharide vaccine in high-risk populations may be modified because of the effectiveness of the newer PCVs. Pediatricians must be aware of the new vaccine strategies for the prevention of IPD and the manifestations of IPD so that prompt empirical therapy can be initiated when treatment is required. [Pediatr Ann. 2023;52(3):e96-e101.].
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Kissler SM, Wang B, Mehrotra A, Barnett M, Grad YH. Impact of Respiratory Infection and Chronic Comorbidities on Early Pediatric Antibiotic Dispensing in the United States. Clin Infect Dis 2022; 76:382-388. [PMID: 36196577 PMCID: PMC9907510 DOI: 10.1093/cid/ciac811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the United States, children aged <5 years receive high volumes of antibiotics, which may contribute to antibiotic resistance. It has been unclear what role preventable illnesses and chronic comorbidities play in prompting antibiotic prescriptions. METHODS We conducted an observational study with a cohort of 124 759 children aged <5 years born in the United States between 2008 and 2013 with private medical insurance. Study outcomes included the cumulative number of antibiotic courses dispensed per child by age 5 and the proportion of children for whom at least 1 antibiotic course was dispensed by age 5. We identified which chronic medical conditions predicted whether a child would be among the top 20% of antibiotic recipients. RESULTS Children received a mean of 6.8 (95% confidence interval [CI]: 6.7-6.9) antibiotic courses by age 5, and 91% (95% CI: 90%-92%) of children had received at least 1 antibiotic course by age 5. Most antibiotic courses (71%; 95% CI: 70%-72%) were associated with respiratory infections. Presence of a pulmonary/respiratory, otologic, and/or immunological comorbidity substantially increase a child's odds of being in the top 20% of antibiotic recipients. Children with at least 1 of these conditions received a mean of 10.5 (95% CI: 10.4-10.6) antibiotic courses by age 5. CONCLUSIONS Privately insured children in the United States receive many antibiotics early in life, largely due to respiratory infections. Antibiotic dispensing varies widely among children, with more antibiotics dispensed to children with pulmonary/respiratory, otologic, and/or immunological comorbidities.
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Affiliation(s)
- Stephen M Kissler
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Bill Wang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Barnett
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yonatan H Grad
- Correspondence: Y. H. Grad, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA ()
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Reingold ELB, Bennion M, Meyer MN. Immunizations in Children With Chronic Diseases: A State of the Science Review With Implications for Practice Change. J Pediatr Health Care 2022; 36:368-375. [PMID: 35120778 DOI: 10.1016/j.pedhc.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/01/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Chronic diseases afflict more than 25% of America's children, and it has been reported that some children with chronic illness are underimmunized, compounding their risks of complications from vaccine-preventable infections. METHOD To better assess vaccination rates in this population, we systematically reviewed PubMed and CINAHL. Publications were included if specific to immunization rates in U.S. children aged < 18 years and were published between 2010 and 2020. A total of 18 studies were reviewed. RESULTS Compared with healthy children, children with chronic illnesses have significantly lower vaccination rates, and they face higher risks if they contract a preventable disease. DISCUSSION Barriers to on-time vaccinations included inadequate education for both parents and providers and misconceptions from nonmedical sources. In addition, lack of provider comfort serves to lower vaccination rates of children with chronic illness. This topic requires further research and discussion until all children are protected from preventable illness.
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9
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Harris JG, Harris LA, Olarte L, Elson EC, Moran R, Blowey DL, El Feghaly RE. Improving Pneumococcal Vaccination Rates in High-risk Children in Specialty Clinics. Pediatrics 2022; 149:185227. [PMID: 35233616 DOI: 10.1542/peds.2020-031724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric patients with immunocompromising or certain chronic medical conditions have an increased risk of acquiring invasive pneumococcal disease (IPD). The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for patients ≥2 years at high risk for IPDs. The aim of this project was to improve PPSV23 vaccination rates for children at high risk for IPD who were seen in 3 specialty clinics from ∼20% to 50% over a 12-month period. METHODS The project team included quality improvement champions from the divisions of rheumatology, infectious diseases, and pulmonology in addition to leaders from our population health management subsidiary. Several initiatives were implemented, starting with review of patient inclusion criteria per the vaccination recommendations, that led to the design and deployment of an automated weekly previsit planning report. Additionally, we implemented a process to stock pneumococcal vaccines and shared best practices among the divisions. We monitored improvement through times series and run charts of PPSV23 vaccination rates. RESULTS The initial PPSV23 vaccination rate for applicable high-risk patients was ∼20%. There was an increase in vaccination rate to ∼60%. All 3 divisions showed improvements in their individual PPSV23 vaccination rates. CONCLUSIONS Using quality improvement methodology, we increased PPSV23 vaccination rates in 3 pediatric specialty clinics, and this improvement was sustained. We will continue to identify best practices and actively recruit additional divisions because we have the opportunity to reach >9000 high-risk patients.
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Affiliation(s)
- Julia G Harris
- Children's Mercy Kansas City, Kansas City, Missouri.,Schools of Medicine
| | - Luke A Harris
- Children's Mercy Kansas City, Kansas City, Missouri.,Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Liset Olarte
- Children's Mercy Kansas City, Kansas City, Missouri.,Schools of Medicine
| | - E Claire Elson
- Children's Mercy Kansas City, Kansas City, Missouri.,Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri
| | - Rachel Moran
- Children's Mercy Kansas City, Kansas City, Missouri.,Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Douglas L Blowey
- Children's Mercy Kansas City, Kansas City, Missouri.,Schools of Medicine.,Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Rana E El Feghaly
- Children's Mercy Kansas City, Kansas City, Missouri.,Schools of Medicine
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10
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Yee ME, Lai KW, Bakshi N, Grossman JK, Jaggi P, Mallis A, Wang YF, Jerris RC, Lane PA, Yildirim I. Bloodstream Infections in Children With Sickle Cell Disease: 2010-2019. Pediatrics 2022; 149:183842. [PMID: 34913059 PMCID: PMC8959248 DOI: 10.1542/peds.2021-051892] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at increased risk for bloodstream infections (BSIs), mainly because of functional asplenia. Immunizations and antibiotic prophylaxis have reduced the prevalence of invasive bacterial infections, but contemporary analysis of BSI in children with SCD is limited. METHODS We conducted a retrospective cohort study of children aged <18 years with SCD who had blood cultures collected at our institution from 2010 to 2019 to identify BSI. Probable contaminant organisms were identified and not included as BSI. We calculated the annual incidence of BSI at our institution with 95% confidence intervals (CIs) and used multivariate logistic regression to evaluate associations. RESULTS There were 2694 eligible patients with 19 902 blood cultures. Excluding repeated cultures and contaminant cultures, there were 156 BSI episodes in 144 patients. The median age at BSI was 7.5 years. The average incidence rate of BSI was 0.89 per 100 person-years (95% CI 0.45-1.32). The most common pathogens were Streptococcus pneumoniae (16.0%), Streptococcus viridans group (9.0%), Escherichia coli (9.0%), Staphylococcus aureus (7.7%), Bordetella holmesii (7.7%), Haemophilus influenzae (7.1%), and Salmonella species (6.4%). Odds of BSI were higher with sickle cell anemia genotypes (odds ratio [OR] 1.88; 95% CI 1.20-2.94) and chronic transfusions (OR 2.66; 95% CI 1.51-4.69) and lower with hydroxyurea (OR 0.57; 95% CI 0.39-0.84). CONCLUSIONS BSI remains a risk for children with SCD. Overall incidence, risk factors, and spectrum of pathogens are important considerations to guide prevention and empirical treatment of suspected infection in SCD.
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Affiliation(s)
- Marianne E. Yee
- Aflac Cancer and Blood Disorders Center,Departments of Pediatrics,Address correspondence to Marianne E. Yee, MD, MSc, Pediatric Hematology/Oncology, Emory University and Children’s Healthcare of Atlanta, 2015 Uppergate Rd, NE, Atlanta, GA 30322. E-mail:
| | | | - Nitya Bakshi
- Aflac Cancer and Blood Disorders Center,Departments of Pediatrics
| | | | | | | | - Yun F. Wang
- Pathology and Laboratory Medicine, School of Medicine,Department of Pathology and Laboratory Medicine, Grady Health System, Atlanta, Georgia
| | - Robert C. Jerris
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia,Pathology and Laboratory Medicine, School of Medicine
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center,Departments of Pediatrics
| | - Inci Yildirim
- Departments of Pediatrics,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Center for Childhood Infections and Vaccines, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
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11
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Stevens JP, Lively A, Jerris R, Yildirim I, Lantis P. Recognition and Outcomes of Pneumococcal Meningitis in 2 Tertiary Pediatric Hospitals Since the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine. Pediatr Emerg Care 2022; 38:e354-e359. [PMID: 33181795 DOI: 10.1097/pec.0000000000002288] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to analyze the demographics, presentation, laboratory findings, and complications of pediatric Streptococcus pneumoniae meningitis since the introduction of the 13-valent pneumococcal conjugate vaccine, to improve recognition, and to minimize patient morbidity and mortality. METHODS This study used a retrospective analysis of pediatric pneumococcal meningitis cases at 2 tertiary healthcare systems in the Southeastern United States from 2010 to 2018. RESULTS We describe 21 cases of pneumococcal meningitis. All patients presented with fever, 95% had altered mental status by history or examination, and 48% had meningeal signs. Forty-three percent had seen another provider within 48 hours of admission. Forty-eight percent had delay in lumbar puncture (LP) of more than 6 hours after antibiotic administration, decreasing rates of positive cerebrospinal fluid cultures from 100% to 40% (P < 0.001). Decision to delay LP was due to either low suspicion for meningitis (n = 4) or clinical instability (n = 6) and was associated with lower rates of meningeal signs (P = 0.014) and higher rates of altered mental status on examination (P = 0.031). Fourteen patients (67%) were up-to-date on pneumococcal immunization. Serotypes were determined in 16 cases, with 2 patients (13%) immunized against the strain that infected them. Primary outcomes included seizures (48%), hearing loss (48%), cranial nerve palsy (33%), and death (5%). Delay in LP with low suspicion for meningitis was associated with longer hospital length of stay approaching statistical significance (P = 0.053). CONCLUSIONS Pneumococcal meningitis remains a relevant and potentially fatal disease despite widespread use of 13-valent pneumococcal conjugate vaccine. Its diagnosis is often delayed during interactions with physicians, which may put patients at increased risk for poor clinical outcomes.
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Lagousi T, Papadatou I, Strempas P, Chatzikalil E, Spoulou V. Pneumococcal Immunization Strategies for High-Risk Pediatric Populations Worldwide: One Size Does Not Fit All. Vaccines (Basel) 2021; 9:vaccines9121390. [PMID: 34960136 PMCID: PMC8704627 DOI: 10.3390/vaccines9121390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 10/25/2022] Open
Abstract
Despite the significant reduction in pneumococcal disease due to pneumococcal vaccines, protection of vulnerable high-risk individuals, especially pediatric populations, remains a great challenge. In an effort to maximize the protection of high-risk children against pneumococcal disease, a combined schedule that includes both conjugate and polysaccharide vaccines is recommended by several countries in the developed world. On the other hand, middle- and low-income countries do not have in place established policies for pneumococcal immunization of children at risk. Pneumococcal conjugate vaccines, despite their benefits, have several limitations, mainly associated with serotype replacement and the wide range of serotype coverage worldwide. In addition, PPV23-impaired immunogenicity and the hyporesponsiveness effect among populations at risk have been well-documented. Therefore, the added value of continuing to include PPV23 in vaccination schedules for high-risk individuals in the years to come remains to be determined by monitoring whether the replacing/remaining serotypes causing IPD are covered by PPV23 to determine whether its benefits outweigh its limitations. In this review, we aim to describe serotype distribution and vaccine efficacy data on pneumococcal disease in the pre- and post-PCV implementation era among high-risk children in both developed and developing countries, assessing the optimization of current recommendations for their vaccination against pneumococcal disease.
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Affiliation(s)
- Theano Lagousi
- Immunobiology Research Laboratory and Infectious Diseases Department “MAKKA”, First Department of Paediatrics, “Aghia Sophia” Children’s Hospital, Athens Medical School, 11527 Athens, Greece; (I.P.); (V.S.)
- Athens Medical School, University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-746-7620
| | - Ioanna Papadatou
- Immunobiology Research Laboratory and Infectious Diseases Department “MAKKA”, First Department of Paediatrics, “Aghia Sophia” Children’s Hospital, Athens Medical School, 11527 Athens, Greece; (I.P.); (V.S.)
- Athens Medical School, University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Strempas
- First Department of Paediatrics, “Aghia Sophia” Children’s Hospital, Athens Medical School, 11527 Athens, Greece; (P.S.); (E.C.)
| | - Elena Chatzikalil
- First Department of Paediatrics, “Aghia Sophia” Children’s Hospital, Athens Medical School, 11527 Athens, Greece; (P.S.); (E.C.)
| | - Vana Spoulou
- Immunobiology Research Laboratory and Infectious Diseases Department “MAKKA”, First Department of Paediatrics, “Aghia Sophia” Children’s Hospital, Athens Medical School, 11527 Athens, Greece; (I.P.); (V.S.)
- Athens Medical School, University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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13
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Age-Dependent Serotype-Associated Case-Fatality Rate in Invasive Pneumococcal Disease in the Autonomous Community of Madrid between 2007 and 2020. Microorganisms 2021; 9:microorganisms9112286. [PMID: 34835413 PMCID: PMC8625439 DOI: 10.3390/microorganisms9112286] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to investigate the serotype-associated fatality rate in cases of invasive pneumococcal disease (IPD) in the Spanish region of Madrid between 2007 and 2020. Serotyping was performed by Pneumotest Latex and the Quellung reaction using commercial antisera. Case-fatality rate was estimated as the ratio between the number of deaths at hospital discharge and the number of cases attributable to each serotype. To evaluate the association measures, the odds ratios with a 95% confidence interval were calculated. Twenty five pneumococcal serotypes were associated to mortality and comprised 87.8% of the total number of isolates characterized. Serotypes 8, 3, 19A, 1, 7F, 22F, 12F, and 11A were the most prevalent (≥3% each). Serotypes 31, 11A, and 19F were significantly associated to high case-fatality rates (>20% each). The lower significantly associated case-fatality rate (<10% each) was found in serotypes 5, 1, 12B, 7F, 12F, 8, 33, and 10A. The serotypes with higher mortality levels (≥0.04 per 100,000 population) were 11A (fatality 24.0%), 3 (fatality 18.7%), 19A (fatality 12.5%), and 8 (fatality 7.2%). Serotype 3 was worrisome because it is associated with important fatality levels combined with very high incidence and mortality rates. Serotype 11A also showed a high fatality with marked incidence and mortality levels. Some few frequent serotypes as 31, 19F, and 15A despite its high fatality had low levels of mortality. By contrast other serotypes as 8 showing low fatality had high mortality ranges because it shows a wide extended distribution. Finally, common serotypes, such as 1 and 5, presented small mortality length, due to their low case-fatality rates.
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14
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Martínez-Osorio J, García-García JJ, Moraga-Llop F, Díaz A, Hernández S, Solé-Ribalta A, González-Peris S, Izquierdo C, Esteva C, Codina G, Planes AM, Uriona S, Campins M, Ciruela P, Salleras L, Domínguez Á, Muñoz-Almagro C, de Sevilla MF. Invasive pneumococcal disease in children under 60 months before and after availability of 13-valent conjugate vaccine. An Pediatr (Barc) 2021; 96:501-510. [PMID: 34238710 DOI: 10.1016/j.anpede.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is the most important bacterial infection in young children, and the introduction of pneumococcal conjugate vaccines has changed its presentation. This study compared the incidence, characteristics and serotype distribution of IPD before and after the introduction of the pneumococcal conjugate vaccine (PCV13). METHODS Prospective enrolment of patients with IPD aged less than 60 months and admitted to either of 2 tertiary care hospitals between January 2007 and December 2009 (pre-PCV13 period) and January 2012 and June-2016 (PCV13 period). RESULTS We identified 493 cases, 319 in the pre-PCV13 period and 174 in the PCV13 period. The incidence of IPD decreased from 89.7 to 34.4 casos per 100 000 habitantes ( -62%; P < .001). This decrease was observed in all forms of disease except necrotising pneumonia (increase from 0.8 to 3.7 casos/100 000 population). There was a significant reduction in all serotypes included in the PCV13 and not included in the PCV7. We did not find significant differences in length of stay, mortality or the frequency of sequelae between both periods, but in the PCV13 period, the length of stay in the paediatric intensive care unit and the duration of mechanical ventilation were longer (P = .00). The incidence of serotype 3 decreased from 10.4 to 6.9 casos per 100 000 population, although it was the serotype involved most frequently in patients with severe disease. CONCLUSIONS After the introduction of the PCV13, there has been a significant decrease in IPD cases. Serotype 3 continues to be an important cause of severe IPD.
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Affiliation(s)
| | - Juan José García-García
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | - Sergi Hernández
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Anna Solé-Ribalta
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | | | - Conchita Izquierdo
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Cristina Esteva
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gemma Codina
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana María Planes
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Uriona
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Magda Campins
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Ciruela
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Luis Salleras
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Ángela Domínguez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mariona F de Sevilla
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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15
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Affiliation(s)
- Liset Olarte
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.,University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Mary Anne Jackson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.,University of Missouri-Kansas City School of Medicine, Kansas City, MO
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16
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Martínez-Osorio J, García-García JJ, Moraga-Llop F, Díaz A, Hernández S, Solé-Ribalta A, González-Peris S, Izquierdo C, Esteva C, Codina G, Planes AM, Uriona S, Campins M, Ciruela P, Salleras L, Domínguez Á, Muñoz-Almagro C, de Sevilla MF. [Invasive pneumococcal disease in children under 60 months before and after availability of 13-valent conjugate vaccine]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00206-X. [PMID: 34217675 DOI: 10.1016/j.anpedi.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is the most important bacterial infection in young children, and the introduction of pneumococcal conjugate vaccines has changed its presentation. This study compared the incidence, characteristics and serotype distribution of IPD before and after the introduction of the pneumococcal conjugate vaccine (PCV13). METHODS Prospective enrolment of patients with IPD aged less than 60 months and admitted to either of 2 tertiary care hospitals between January 2007 and December 2009 (pre-PCV13 period) and January 2012 and June-2016 (PCV13 period). RESULTS We identified 493 cases, 319 in the pre-PCV13 period and 174 in the PCV13 period. The incidence of IPD decreased from 89.7 to 34.4 cases per 100,000 population (-62%; P<.001). This decrease was observed in all forms of disease except necrotising pneumonia (increase from 0.8 to 3.7 cases/100,000 population). There was a significant reduction in all serotypes included in the PCV13 and not included in the PCV7. We did not find significant differences in length of stay, mortality or the frequency of sequelae between both periods, but in the PCV13 period, the length of stay in the paediatric intensive care unit and the duration of mechanical ventilation were longer (P=.00). The incidence of serotype 3 decreased from 10.4 to 6.9 cases per 100,000 population, although it was the serotype involved most frequently in patients with severe disease. CONCLUSIONS After the introduction of the PCV13, there has been a significant decrease in IPD cases. Serotype 3 continues to be an important cause of severe IPD.
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Affiliation(s)
| | - Juan José García-García
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España
| | | | | | - Sergi Hernández
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, España
| | | | | | - Conchita Izquierdo
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, España
| | - Cristina Esteva
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España
| | - Gemma Codina
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Ana María Planes
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Sonia Uriona
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Magda Campins
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Pilar Ciruela
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, España
| | - Luis Salleras
- Departament de Medicina, Universitat de Barcelona, Barcelona, España
| | - Ángela Domínguez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España; Departament de Medicina, Universitat de Barcelona, Barcelona, España
| | - Carmen Muñoz-Almagro
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España; Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, España
| | - Mariona F de Sevilla
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España
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17
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Grammatico‐Guillon L, Jafarzadeh SR, Laurent E, Shea K, Pasco J, Astagneau P, Adams W, Pelton S. Gradual decline in outpatient antibiotic prescriptions in paediatrics: A data warehouse-based 11-year cohort study. Acta Paediatr 2021; 110:611-617. [PMID: 32573837 DOI: 10.1111/apa.15439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe trends in antibiotic (AB) prescriptions in children in primary care over 11 years, using a large data warehouse. METHODS A retrospective cohort study assessed outpatient AB prescriptions 2007-2017, using the Massachusetts Health Disparities Repository. The evolution of paediatric outpatient AB prescriptions was assessed using time-series analyses through annual per cent change (APC) for the population and for children with or without comorbid condition. RESULTS About 25 000 children were followed in primary care with 31 248 AB prescriptions reported in the data warehouse. The youngest children had more AB prescriptions. Penicillins were prescribed most frequently (46%), then macrolides (28%). One third of children had comorbid conditions, receiving significantly more antibiotics (30.3 vs 21.0 AB/100 child-years, relative risk: 1.43, 95% CI: 1.40, 1.46). Overall AB prescription decreased over the period (APC = -5.34%, 95% CI: -7.10, -3.54), with similar trends for penicillins (APC = -5.49; 95% CI: -8.27, -2.62) and macrolides (APC = -6.46; 95% CI: -8.37, -4.58); antibiotic prescribing declined more in children with comorbid conditions. CONCLUSION Outpatient AB prescribing decline was gradual and consistent in paediatrics over the period. Prescription differences persisted between age groups, conditions and indication. The availability of routine care data through data warehouse fosters the surveillance automation, providing inexpensive fast tools to design appropriate antimicrobial stewardship.
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Affiliation(s)
- Leslie Grammatico‐Guillon
- Medical School and School of Public Health Boston University Boston MA USA
- Public Health, Epidemiology Unit (EpiDcliC) Teaching Hospital of Tours University of Tours Tours France
| | - S. Reza Jafarzadeh
- Clinical Epidemiology Research and Training Unit Boston University School of Medicine Boston MA USA
| | - Emeline Laurent
- Public Health, Epidemiology Unit (EpiDcliC) Teaching Hospital of Tours University of Tours Tours France
- Research unit EA 7505 "Education Ethique et Santé" University of Tours Tours France
| | - Kimberly Shea
- Medical School and School of Public Health Boston University Boston MA USA
| | - Jeremy Pasco
- Research unit EA 7505 "Education Ethique et Santé" University of Tours Tours France
- Public Health Clinical Data Centre Teaching Hospital of Tours Tours France
| | - Pascal Astagneau
- Reference Centre for Prevention of Healthcare‐Associated Infections Faculty of Medicine, APHP University Hospital and Department of Public Health Sorbonne University Paris France
| | - William Adams
- Service of Bioinformatics Boston University Medical School Boston MA USA
| | - Stephen Pelton
- Medical School and School of Public Health Boston University Boston MA USA
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18
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Emergence of Meningitis Caused by Nonvaccine Serotypes of Pneumococcus in Rural United States. Case Rep Pediatr 2020; 2020:2372843. [PMID: 33294245 PMCID: PMC7718068 DOI: 10.1155/2020/2372843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/26/2020] [Accepted: 11/21/2020] [Indexed: 11/24/2022] Open
Abstract
Pneumococcal conjugate vaccines have decreased the rates of invasive pneumococcal disease (IPD) in children. Since vaccine introduction, however, rates of infection due to nonvaccine Streptococcus pneumoniae serotypes have increased. We now describe 3 meningitis cases due to the nonvaccine serotypes 35B and 11A from rural United States.
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19
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Invasive Streptococcus pneumoniae Infections and Vaccine Failures in Children in Ireland From the Postvaccine Era From 2007 to 2018. Pediatr Infect Dis J 2020; 39:339-344. [PMID: 31815827 DOI: 10.1097/inf.0000000000002549] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) causes life-threatening illnesses including meningitis and bloodstream infection. Here, we report the impact of 7- and 13-valent pneumococcal conjugate vaccines (PCV7/PCV13) after introduction into the Irish pediatric immunization schedule in 2008 and 2010, respectively, and the clinical details surrounding suspected PCV vaccine failures. METHODS Serotyping and antimicrobial susceptibility testing of all culture-confirmed cases referred from children <16 years of age from July 2007 to June 2018 were assessed. Surveillance data were assessed to identify any potential vaccine failures. RESULTS The number of IPD cases has decreased by >50% since the introduction of PCVs. The most significant decline PCV serotypes in children <2 years of age, with a 97% decline in PCV7 serotypes, incidence rate ratio (IRR) 0.03, 95% confidence interval (CI): 0.00-0.21; and a 78% decline PCV13-only (PCV13-7) serotypes, IRR 0.22, 95% CI: 0.05-1.04, respectively. However, there has been an increase in non-PCV13 serotypes in children <2 years during the same period (IRR: 2.82, 95% CI: 1.02-7.84; P = 0.0463), with similar serotype trends observed for those 2-4 and 5-15 years of age. There were no clear vaccine replacement serotypes, instead a number of different serotypes emerged. Sixteen vaccine failures were identified, 10 of which were postbooster vaccine failures. Most failures were serotype 19A and resistant to antimicrobials. CONCLUSIONS Further reducing the incidence of IPD is more challenging as the number of non-PCV13 serotypes has expanded and is now less susceptible to antimicrobials. Consequently, higher valency or broader target vaccines are now required to further prevent IPD in children.
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Lemma M, Bekele Y, Petkov S, Hägglund M, Petros B, Aseffa A, Howe R, Chiodi F. Streptococcus pneumoniae Nasopharyngeal Carriage among PCV-10-Vaccinated HIV-1-Infected Children with Maintained Serological Memory in Ethiopia. Pathogens 2020; 9:pathogens9030159. [PMID: 32106620 PMCID: PMC7157605 DOI: 10.3390/pathogens9030159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/19/2020] [Accepted: 02/23/2020] [Indexed: 11/16/2022] Open
Abstract
Streptococcus pneumoniae (S. pneumoniae) vaccines have substantially reduced the burden of invasive pneumococcal diseases (IPDs) worldwide. Despite high coverage with S. pneumoniae vaccination, upper-respiratory-tract colonization by S. pneumoniae is still common. We assessed maintenance of serological responses to S. pneumoniae serotypes included in PCV-10 by ELISA in HIV-1-infected children (n = 50) and age-matched controls (n = 50) in Ethiopia. We isolated S. pneumoniae in nasopharyngeal swabs and determined S. pneumoniae serotype by whole genome sequencing (WGS). Comparable levels of S. pneumoniae serotype-specific IgG concentrations were detected in plasma of HIV-1-infected children and matched controls, with geometric mean concentrations (GMCs) consistently higher than the protective threshold for PCV-10 serotypes of 0.35 μg/mL. We isolated S. pneumoniae from 38 (out of 97) nasopharyngeal swabs, 25 from HIV-1-infected children and 13 from controls. WGS based serotyping revealed 22 known S. pneumoniae serotypes and 2 nontypeable (NT) isolates. Non-PCV-10 serotypes represented >90% of isolates. We showed that HIV-1-infected children and matched controls in Ethiopia carry a level of maintained serological memory to PCV-10 considered protective for IPDs. We identified a higher proportion of nasopharyngeal carriage with highly pathogenic S. pneumoniae non-PCV strains among HIV-1-infected children compared to controls.
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Affiliation(s)
- Mahlet Lemma
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Solnavägen 9, 17165 Solna, Sweden
- Armauer Hansen Research Institute, Jimma Road, ALERT compound P.O. Box 1005, Addis Ababa, Ethiopia
- Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Arat Kilo Campus, Addis Ababa, Ethiopia
| | - Yonas Bekele
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Solnavägen 9, 17165 Solna, Sweden
| | - Stefan Petkov
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Solnavägen 9, 17165 Solna, Sweden
| | - Moa Hägglund
- Science for Life Laboratory, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 17165 Solna, Sweden
| | - Beyene Petros
- Department of Microbial, Cellular and Molecular Biology, Addis Ababa University, Arat Kilo Campus, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Jimma Road, ALERT compound P.O. Box 1005, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Jimma Road, ALERT compound P.O. Box 1005, Addis Ababa, Ethiopia
| | - Francesca Chiodi
- Department of Microbiology, Tumor and Cell Biology, Biomedicum, Karolinska Institutet, Solnavägen 9, 17165 Solna, Sweden
- Correspondence:
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Who is at risk of 13-valent conjugated pneumococcal vaccine failure? Vaccine 2020; 38:1671-1677. [DOI: 10.1016/j.vaccine.2019.12.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
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Changing Epidemiology and Predisposing Factors for Invasive Pneumococcal Disease at Two Australian Tertiary Hospitals. Pediatr Infect Dis J 2020; 39:1-6. [PMID: 31815835 DOI: 10.1097/inf.0000000000002489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is associated with significant morbidity and mortality in children. Universal pneumococcal conjugate vaccination has changed the epidemiology of IPD. In vaccinated children, IPD can be a marker of an underlying immunodeficiency. METHODS This is a retrospective audit of children younger than 18 years with IPD admitted to 2 tertiary pediatric hospitals in Australia between 2011 and 2017. Data on predisposing conditions, immunologic evaluation, pneumococcal serotype, antibiotic susceptibility and treatment were collected. RESULTS During the 7-year period, there were 131 presentations with IPD in 127 children; 3 children had recurrent IPD. Patients presented with sepsis (41%), empyema (29%), meningitis (18%), mastoiditis (12%), pneumonia (10%) and septic arthritis (4%). In 19 (15%) presentations, risk factors for IPD were present, including malignancy, hematologic disorder, chronic liver disease, chronic kidney disease and cochlear implant. Pneumococcal serotypes were determined in 78/131 (60%) of presentations: the most frequent serotypes were 19A (19%), 3 (13%), 7F (10%) and 19F (8%) and non-vaccine serotypes 22F (8%), 35B (6%), 15A (4%) and 38 (4%). Overall, 11% of isolates were non-susceptible to ceftriaxone. Only 36 patients (32%) had an immunologic evaluation, and 4 patients had proven or probable immunodeficiency. CONCLUSION Although pneumococcal conjugate vaccine serotypes 19A, 3, 19F and 7F remain frequent causes of IPD, non-vaccine serotypes are emerging. Our data support vancomycin treatment for children with pneumococcal meningitis given 11% of our isolates were not susceptible to ceftriaxone. It is important to consider underlying conditions predisposing to IPD in a population with high rates of pneumococcal vaccination.
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Pelton SI, Lapidot R, Yildirim I. Invasive Pneumococcal Disease-Not Evenly Shared by All Children. JAMA Pediatr 2019; 173:1023-1024. [PMID: 31566674 DOI: 10.1001/jamapediatrics.2019.3185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Stephen I Pelton
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Rotem Lapidot
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Inci Yildirim
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Center for Childhood Infections and Vaccines, Atlanta, Georgia
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Butters C, Phuong LK, Cole T, Gwee A. Prevalence of Immunodeficiency in Children With Invasive Pneumococcal Disease in the Pneumococcal Vaccine Era: A Systematic Review. JAMA Pediatr 2019; 173:1084-1094. [PMID: 31566672 DOI: 10.1001/jamapediatrics.2019.3203] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite increasing access to vaccination, invasive pneumococcal disease (IPD) is responsible for approximately 826 000 deaths worldwide in children younger than 5 years each year. To allow early identification and prevention, an improved understanding of risk factors for IPD is needed. OBJECTIVES To review the literature on the prevalence of primary immunodeficiency (PID) in children younger than 18 years presenting with IPD without another predisposing condition and to inform guidelines for immunologic evaluation after the first episode of IPD based on published evidence. EVIDENCE REVIEW A literature search of PubMed, Embase (inception [1974] to February 28, 2019), and MEDLINE (inception [1946] to February 28, 2019) was conducted using the terms Streptococcus pneumonia, Streptococcus pneumoniae, pneumococcal infection, Streptococcus infection, pneumococcal meningitis, immunodeficiency, immune response, immunocompromised, susceptib*, precursor, predispose*, recurren*, newborn, neonat*, infan*, toddler, child, preschooler, adolescen*, and pediatric. Publications reporting original data on immunodeficiency in children with microbiologically confirmed primary or recurrent IPD were included. Strength of clinical data was graded according to the 5-point scale of the Oxford Centre for Evidence-Based Medicine. FINDINGS In 6022 unique children with primary IPD, 5 of 393 (1.3%) to 17 of 162 (10.5%) of all children and 14 of 53 (26.4%) of those older than 2 years had a PID identified. Higher rates of PID, up to 10 of 15 (66.7%), were found in children with recurrent IPD. Antibody deficiency was the most common immunodeficiency, followed by complement deficiency, asplenia, and rarer defects in T-cell signaling. The site of infection was a key indicator for the risk of underlying PID, with the greatest risk of PID in children with meningitis or complicated pneumonia. CONCLUSIONS AND RELEVANCE Results of this study suggest that invasive pneumococcal disease, and particularly recurrent IPD, is an important marker of underlying PID in children without other risk factors. The findings also suggest that children older than 2 years with pneumococcal meningitis or complicated pneumonia and all children with recurrent IPD should be referred for an immune evaluation. TRIAL REGISTRATION PROSPERO identifier: CRD42017075978.
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Affiliation(s)
- Coen Butters
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Parkville, Australia
| | - Linny Kimly Phuong
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Parkville, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Amanda Gwee
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Parkville, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Infectious Diseases & Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Australia
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Chan J, Nguyen CD, Dunne EM, Kim Mulholland E, Mungun T, Pomat WS, Rafai E, Satzke C, Weinberger DM, Russell FM. Using pneumococcal carriage studies to monitor vaccine impact in low- and middle-income countries. Vaccine 2019; 37:6299-6309. [PMID: 31500968 DOI: 10.1016/j.vaccine.2019.08.073] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/13/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
Abstract
Pneumococcal disease is a leading cause of childhood mortality, globally. The pneumococcal conjugate vaccine (PCV) has been introduced to many countries worldwide. However there are few studies evaluating PCV impacts in low- and middle-income countries (LMIC) because measuring the impact of PCV on pneumococcal disease in LMICs is challenging. We review the role of pneumococcal carriage studies for the evaluation of PCVs in LMICs and discuss optimal methods for conducting these studies. Fifteen carriage studies from 13 LMICs quantified the effects of PCV on carriage, and identified replacement carriage serotypes in the post-PCV era. Ten studies reported on the indirect effects of PCV on carriage. Results can be used to inform cost-effectiveness evaluations, guide policy decisions on dosing and product, and monitor equity in program implementation. Critically, we highlight gaps in our understanding of serotype replacement disease in LMICs and identify priorities for research to address this gap.
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Affiliation(s)
- Jocelyn Chan
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
| | - Cattram D Nguyen
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Eileen M Dunne
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - E Kim Mulholland
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tuya Mungun
- National Center of Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Infection and Immunity Unit, Goroka, Papua New Guinea; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | - Catherine Satzke
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, United States
| | - Fiona M Russell
- New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia; Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
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Long-term Vaccine Impact on Invasive Pneumococcal Disease Among Children With Significant Comorbidities in a Large Australian Birth Cohort. Pediatr Infect Dis J 2019; 38:967-973. [PMID: 31408056 DOI: 10.1097/inf.0000000000002407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about long-term invasive pneumococcal disease (IPD) incidence in children with risk factors (RFs) in populations with high coverage pneumococcal conjugate vaccine (PCV) programs. We measured IPD burden and changes with PCV use in children by RF status. METHODS A retrospective cohort of all live births in 2001-2012 in New South Wales, Australia was linked to IPD, hospitalization and death data. RFs were identified from International Classification of Diseases codes in linked hospitalizations. For each RF adjusted hazard ratios (aHRs, using Cox models), population attributable fractions (PAFs) and changes post-PCV relative to baseline for IPD were calculated. RESULTS One-thousand two-hundred fifty-one IPD cases occurred in ~1.1 million children in 12-year study cohort. The 75,404 children (6.8% of cohort) with RFs accounted for 255 (20.4%) IPD cases [rate (per 100,000 person-years) of 61 compared with 14 in no RFs]. Asthma was most common RF (n = 41,074; 3.6%) but highest IPD risk was in 2452 children (0.2%) with immunosuppression, splenic dysfunction or breach in cerebrospinal fluid barrier (aHR~20; PAF 0.7-1.8%) versus asthma (aHR 5.3; PAF 14.8%). Compared with 2001-2004 birth cohort (baseline), IPD incidence in PCV-eligible 2009-2012 birth cohort was 78% (95% confidence interval: -72% to -82%) less in children without RFs. IPD declined nonsignificantly (13%; 95% confidence interval: -70% to +138%) in highest IPD risk group, but by 67% (-43% to -82%) in children with other RFs. CONCLUSIONS By 8 years of universal PCV, IPD incidence reduced significantly in all children except in the 0.2% at highest risk, for whom antibiotic prophylaxis and additional vaccine doses are recommended but compliance and effectiveness remain uncertain.
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Kaplan SL, Barson WJ, Lin PL, Romero JR, Bradley JS, Tan TQ, Pannaraj PS, Givner LB, Hulten KG. Invasive Pneumococcal Disease in Children's Hospitals: 2014-2017. Pediatrics 2019; 144:peds.2019-0567. [PMID: 31420369 DOI: 10.1542/peds.2019-0567] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The 13-valent pneumococcal conjugate vaccine (PCV13) was licensed in the United States in 2010. We describe invasive pneumococcal disease (IPD) in children at 8 children's hospitals in the US from 2014 to 2017. METHODS Children with IPD occurring from 2014 to 2017 were identified from a prospective study. Demographic and clinical data, including results of any immune evaluation along with the number and dates of previous pneumococcal conjugate vaccines administered, were recorded on case report forms. Isolate serotypes were determined in a central laboratory. Pneumococcal conjugate vaccine doses were counted if IPD occurred ≥2 weeks after a dose. RESULTS PCV13 serotypes accounted for 23.9% (115 out of 482) of IPD isolates from 2014 to 2017. Serotypes 3, 19A, and 19F accounted for 91% of PCV13 serotypes. The most common non-PCV13 serotypes were 35B, 23B, 33F, and 22F. An underlying condition was significantly (P < .0001) more common in children with IPD due to non-PCV13 serotypes (200 out of 367, 54.5%) than for children with PCV13 serotypes (27 out of 115, 23.5%). An immune evaluation was undertaken in 28 children who received ≥2 PCV13 doses before IPD caused by a PCV13 serotype. Only 1 was found to have an immunodeficiency. CONCLUSIONS PCV13 serotypes (especially serotypes 3, 19A, and 19F) continue to account for nearly a quarter of IPD in US children 4 to 7 years after PCV13 was introduced. Underlying conditions are more common in children with non-PCV13 serotype IPD. Immune evaluations in otherwise healthy children with PCV13 serotype IPD despite receiving ≥2 PCV13 doses did not identify an immunodeficiency.
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Affiliation(s)
- Sheldon L Kaplan
- Department of Pediatrics, Pediatric Infectious Diseases Section, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas;
| | - William J Barson
- Department of Pediatrics, Nationwide Children's Hospital and College of Medicine and Public Health, The Ohio State University, Columbus, Ohio
| | - Philana Ling Lin
- Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - José R Romero
- Department of Pediatrics, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - John S Bradley
- Department of Pediatrics, Rady Children's Hospital-San Diego and University of California, San Diego, San Diego, California
| | - Tina Q Tan
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Pia S Pannaraj
- Department of Pediatrics, Children's Hospital Los Angeles and School of Medicine, University of Southern California, Los Angeles, California; and
| | - Laurence B Givner
- Department of Pediatrics, Brenner Children's Hospital and Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Kristina G Hulten
- Department of Pediatrics, Pediatric Infectious Diseases Section, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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Grammatico-Guillon L, Shea K, Jafarzadeh SR, Camelo I, Maakaroun-Vermesse Z, Figueira M, Adams WG, Pelton S. Antibiotic Prescribing in Outpatient Children: A Cohort From a Clinical Data Warehouse. Clin Pediatr (Phila) 2019; 58:681-690. [PMID: 30884973 DOI: 10.1177/0009922819834278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To characterize antibiotic (ab) prescriptions in children. METHODS Evaluation of outpatient ab prescriptions in a 3-year cohort of children in primary care using a data warehouse (Massachusetts Health Disparities Repository) by comorbid conditions, demographics, and clinical indication. RESULTS A total of 15 208 children with nearly 120 000 outpatient visits were included. About one third had a comorbid condition (most commonly asthma). Among the 30 000 ab prescriptions, first-line penicillins and macrolides represented the most frequent ab (70%), followed by cephalosporins (16%). Comorbid children had 54.3 ab prescriptions/100 child-years versus 38.8 in children without comorbidity; ab prescription was higher in urinary tract infections (>60% of episodes), otitis, lower respiratory tract infections (>50%), especially in comorbid children and children under 2 year old. Ab prescriptions were significantly associated with younger age, emergency room visit, comorbid children, and acute infections. DISCUSSION A clinical data warehouse could help in designing appropriate antimicrobial stewardship programs and represent a potential assessment tool.
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Affiliation(s)
- Leslie Grammatico-Guillon
- 1 Boston University, Boston, MA, USA.,2 Teaching Hospital of Tours, University of Tours, Tours, France
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Chang AB, Redding GJ. Bronchiectasis and Chronic Suppurative Lung Disease. KENDIG'S DISORDERS OF THE RESPIRATORY TRACT IN CHILDREN 2019. [PMCID: PMC7161398 DOI: 10.1016/b978-0-323-44887-1.00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shi W, Li J, Dong F, Qian S, Liu G, Xu B, Zhou L, Xu W, Meng Q, Wang Q, Shen K, Ma L, Yao K. Serotype distribution, antibiotic resistance pattern, and multilocus sequence types of invasive Streptococcus pneumoniae isolates in two tertiary pediatric hospitals in Beijing prior to PCV13 availability. Expert Rev Vaccines 2018; 18:89-94. [PMID: 30526145 DOI: 10.1080/14760584.2019.1557523] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is a serious threat to children worldwide. This study reported the serotype distribution, antibiotic resistance pattern, and multilocus sequence types of 111 IPD strains isolated from children less than 14 years old in two tertiary pediatric centers in Beijing during the years 2012-2017. METHODS Serotypes were determined using Quellung reaction. Antibiotic resistance was tested using the E-test or disc diffusion method. Sequence types (STs) were assigned via multilocus sequence typing. RESULTS The most common serotypes of the IPD isolates were 19F, 19A, 14, 23F, and 6B, and the PCV13 coverage rate was 90.1%. For the meningitis isolates, the resistance rate to penicillin was 95.7%, and the non-susceptibility rate to ceftriaxone was 65.2%. All of the non-meningitis isolates were susceptible to penicillin, and the susceptibility rate to ceftriaxone was 89.8%. All but one of the isolates were highly resistant to erythromycin. The multidrug resistance rate of all isolates was 89.2%. The most common STs were ST320, ST271, ST876, and ST81, which belonged to serotype 19A, 19F, 14, and 23F, respectively. CONCLUSION Given the high coverage rate of PCV13 and the worrisome non-susceptibility rate of IPD isolates to antibiotics, PCV13 use would be beneficial for Chinese children.
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Affiliation(s)
- Wei Shi
- a Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases , National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
| | - Jing Li
- b Department of Clinical Laboratory , Capital Institute of Pediatrics , Beijing , China
| | - Fang Dong
- c Clinical Laboratory, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Suyun Qian
- d Pediatric Intensive Care Unit, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Gang Liu
- e Department of Infectious Diseases, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Baoping Xu
- f Department of Respiratory, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Lin Zhou
- b Department of Clinical Laboratory , Capital Institute of Pediatrics , Beijing , China
| | - Wenjian Xu
- b Department of Clinical Laboratory , Capital Institute of Pediatrics , Beijing , China
| | - Qinghong Meng
- a Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases , National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
| | - Qing Wang
- a Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases , National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
| | - Kunling Shen
- f Department of Respiratory, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Lijuan Ma
- b Department of Clinical Laboratory , Capital Institute of Pediatrics , Beijing , China
| | - Kaihu Yao
- a Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases , National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
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Reeves SL, Jary HK, Gondhi JP, Kleyn M, Wagner AL, Dombkowski KJ. Pneumococcal vaccination coverage among children with sickle cell anemia, sickle cell trait, and normal hemoglobin. Pediatr Blood Cancer 2018; 65:e27282. [PMID: 29905397 DOI: 10.1002/pbc.27282] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/02/2018] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Children with sickle cell anemia and sickle cell trait are at an increased risk of invasive pneumococcal disease compared to children with normal hemoglobin. We assessed and compared pneumococcal vaccination status among these three groups. PROCEDURE Children with sickle cell anemia and sickle cell trait were identified using Michigan newborn screening records (1997-2014); each child was matched to four children with normal hemoglobin based on age, Medicaid enrollment (at least 1 year from 2012-2014), race, and census tract. Vaccination records were obtained from the state's immunization system. Pneumococcal vaccine coverage (PCV7 or PCV13 depending on date of administration) was assessed at milestone ages of 3, 5, 7, and 16 months. The proportion of children with vaccine coverage at each milestone was calculated overall and compared among children with sickle cell anemia, sickle cell trait, and normal hemoglobin using chi-square tests. RESULTS The study population consisted of 355 children with sickle cell anemia, 17,319 with sickle cell trait, and 70,757 with normal hemoglobin. The proportion of children with age-appropriate pneumococcal vaccination coverage was low at each milestone and generally decreased over time. Children with sickle cell anemia were more likely to be covered compared to children with sickle cell trait or normal hemoglobin. CONCLUSIONS Despite higher pneumococcal vaccination coverage among children with sickle cell anemia, opportunities for improvement exist among all children. Targeted interventions will benefit from mechanisms to identify children with increased risks such as sickle cell anemia or trait to improve pneumococcal vaccination coverage among these groups.
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Affiliation(s)
- Sarah L Reeves
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Hannah K Jary
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Jennifer P Gondhi
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Mary Kleyn
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Kevin J Dombkowski
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
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Reeves SL, Tribble A, Madden B, Freed GL, Dombkowski KJ. Antibiotic Prophylaxis for Children With Sickle Cell Anemia. Pediatrics 2018; 141:peds.2017-2182. [PMID: 29437860 PMCID: PMC7252515 DOI: 10.1542/peds.2017-2182] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children with sickle cell anemia (SCA) are at increased risk for invasive pneumococcal disease; antibiotic prophylaxis significantly reduces this risk. We calculated the proportion of children with SCA who received ≥300 days of antibiotic prophylaxis and identified predictors of such receipt. METHODS Children aged 3 months to 5 years with SCA were identified by the presence of 3 or more Medicaid claims with a diagnosis of SCA within a calendar year (2005-2012) in Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. Receipt of antibiotics was identified through claims for filled prescriptions. The outcome, receipt of ≥300 days of antibiotics, was assessed annually by using varying classifications of antibiotics. By using logistic regression with generalized estimating equations, we estimated the odds of receiving ≥300 days of antibiotics, with potential predictors of age, sex, year, state, and health services use. RESULTS A total of 2821 children contributed 5014 person-years. Overall, only 18% of children received ≥300 days of antibiotics. Each additional sickle cell disease-related outpatient visit (odds ratio = 1.01, 95% confidence interval: 1.01-1.02) and well-child visit (odds ratio = 1.08, 95% confidence interval: 1.02-1.13) was associated with incrementally increased odds of receiving ≥300 days of antibiotics. CONCLUSIONS Despite national recommendations and proven lifesaving benefit, antibiotic prophylaxis rates are low among children with SCA. Numerous health care encounters may offer an opportunity for intervention; in addition, such interventions likely need to include social factors that may affect the ability for a child to receive and adhere to antibiotic prophylaxis.
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Affiliation(s)
- Sarah L Reeves
- Department of Pediatrics and Communicable Diseases and .,Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, Michigan
| | - Alison Tribble
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Brian Madden
- Child Health Evaluation and Research (CHEAR) Center, Department of Pediatrics and Communicable Diseases; University of Michigan, Ann Arbor, MI
| | - Gary L Freed
- Child Health Evaluation and Research (CHEAR) Center, Department of Pediatrics and Communicable Diseases; University of Michigan, Ann Arbor, MI
| | - Kevin J Dombkowski
- Child Health Evaluation and Research (CHEAR) Center, Department of Pediatrics and Communicable Diseases; University of Michigan, Ann Arbor, MI
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Coleman FT, Blahna MT, Kamata H, Yamamoto K, Zabinski MC, Kramnik I, Wilson AA, Kotton DN, Quinton LJ, Jones MR, Pelton SI, Mizgerd JP. Capacity of Pneumococci to Activate Macrophage Nuclear Factor κB: Influence on Necroptosis and Pneumonia Severity. J Infect Dis 2017; 216:425-435. [PMID: 28368460 DOI: 10.1093/infdis/jix159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 03/23/2017] [Indexed: 12/13/2022] Open
Abstract
During pneumococcal pneumonia, antibacterial defense requires the orchestrated expression of innate immunity mediators, initiated by alveolar macrophages and dependent on transcription driven by nuclear factor κB (NF-κB). Such immune pressure may select for pneumococci, which avoid or subvert macrophage NF-κB activation. Analyzing pneumococci collected from children in Massachusetts, we found that the activation of macrophage NF-κB by Streptococcus pneumoniae is highly diverse, with a preponderance of low NF-κB activators that associate particularly with complicated pneumonia. Low NF-κB activators cause more severe lung infections in mice, and they drive macrophages toward an alternate and detrimental cell fate of necroptosis. Both outcomes can be reversed by activation of macrophages with pneumococci that are high NF-κB activators. These results suggest that low NF-κB activation is a virulence property of pneumococci and that the appropriate activation of macrophages, including NF-κB, may hold promise as an adjunct therapeutic avenue for pneumococcal pneumonia.
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Affiliation(s)
| | | | | | | | | | - Igor Kramnik
- Pulmonary Center.,Department of Microbiology.,Deparment of Medicine
| | | | | | - Lee J Quinton
- Pulmonary Center.,Deparment of Medicine.,Department of Pathology and Laboratory Medicine
| | | | | | - Joseph P Mizgerd
- Pulmonary Center.,Department of Microbiology.,Deparment of Medicine.,Department of Biochemistry, Boston University School of Medicine, Massachusetts
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Yildirim I, Little BA, Finkelstein J, Lee G, Hanage WP, Shea K, Pelton SI. Surveillance of pneumococcal colonization and invasive pneumococcal disease reveals shift in prevalent carriage serotypes in Massachusetts' children to relatively low invasiveness. Vaccine 2017. [PMID: 28645717 DOI: 10.1016/j.vaccine.2017.05.077] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Following the introduction of pneumococcal conjugate vaccines (PCV), overall nasopharyngeal colonization rates have not changed significantly, however a dramatic and sustained decline in invasive pneumococcal disease (IPD) in children was observed in every setting where the PCVs were implemented. We aimed to describe the differences in invasive disease potential of serotypes that are common colonizers in pre- and post-vaccine eras in order to provide further insight in our understanding of dynamic epidemiology of pneumococcal diseases. METHODS Using data from surveillance of nasopharyngeal carriage and enhanced surveillance for IPD, a serotype specific "invasive capacity (IC)" was computed by dividing the incidence of IPD due to serotype x by the carriage prevalence of that same serotype in children <7years of age in Massachusetts. We have evaluated the serotype specific invasive capacity in two periods; pre-PCV13 (2001/02, 2003/04, 2006/07, 2008/09) and post-PCV13 (2010/11 and 2013/14), and by age groups; <24monthsvs. ≥24months. RESULTS An approximate 50-fold variation in the point estimate was observed between the serotypes having the highest (7F, 38, 19A, 3, 33F) and the lowest (6C, 35B, 21, 11A, 23B and 23A) computed serotype specific invasive disease potential. In the post-PCV13 era (6C, 35B, 11A, 23B and 23A), 5 of the 7 most common serotypes colonizing the nasopharynx were serotypes with the lowest invasive capacity. Serotype specific invasive capacity trended down in older children for majority of the serotypes, and serotypes 3, 10A and 19A had significantly lower invasive capacity in children older than 24months of age compared to younger children. CONCLUSION Invasive capacity differs among serotypes and likely by age. Point estimates of IC for most of the common serotypes colonizing children in Massachusetts in post-PCV13 era were low and likely explain the continued reduction in IPD from the pre-PCV era in the absence of specific protection against these serotypes.
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Affiliation(s)
- I Yildirim
- School of Medicine, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA.
| | - B A Little
- Maxwell Finland Laboratories, Boston Medical Center, Boston, MA, USA
| | - J Finkelstein
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - G Lee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
| | - W P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - K Shea
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - S I Pelton
- Maxwell Finland Laboratories, Boston Medical Center, Boston, MA, USA; Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA; School of Medicine, Boston University, Boston, MA, USA
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Houri H, Tabatabaei SR, Saee Y, Fallah F, Rahbar M, Karimi A. Distribution of capsular types and drug resistance patterns of invasive pediatric Streptococcus pneumoniae isolates in Teheran, Iran. Int J Infect Dis 2017; 57:21-26. [PMID: 28131730 DOI: 10.1016/j.ijid.2017.01.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/16/2017] [Accepted: 01/18/2017] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To explore the serotype distribution and drug resistance patterns of invasive pneumococcal isolates from children under 5 years of age. METHODS During a 32-month period, 585 clinical samples (including blood, cerebrospinal fluid (CSF), and synovial fluid) from children suspected of having meningitis, sepsis, pneumonia, or septic arthritis were analyzed using the BACTEC culture system. Positive cultures were examined using biochemical tests and lytA amplification for the identification of pneumococcal strains. The confirmed pneumococcal isolates were examined to determine capsular types using a modified sequential multiplex PCR and susceptibility to antimicrobial agents. RESULTS Fifty-three pneumococcal isolates were detected in the 585 clinical samples: 21 (39.6%) blood samples and 32 (60.4%) CSF samples. The most frequent serotype was 23F (24.5%), followed by serotypes 19F (18.9%), 19A (7.5%), and 9V (7.5%). Twenty-one percent of pneumococcal isolates were penicillin-non-susceptible and serotype 19A was significantly associated with resistance to penicillin. CONCLUSIONS This study indicated that the 13-valent pneumococcal conjugate vaccine (PCV13) could cover the majority of the invasive pneumococcal isolates. Drug-resistant and multidrug-resistant Streptococcus pneumoniae strains are circulating in Iran. Therefore, public immunization of infants using PCV13 is recommended to reduce the incidence of pneumococcal disease and pneumococcal-resistant strains in Teheran.
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Affiliation(s)
- Hamidreza Houri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Rafiei Tabatabaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Yasaman Saee
- Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Fallah
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Rahbar
- Health Reference Laboratories, Research Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Abdollah Karimi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Universal immunization of infants and toddlers with pneumococcal conjugate vaccines over the last 15 years has dramatically altered the landscape of pneumococcal disease. Decreases in invasive pneumococcal disease, all-cause pneumonia, empyema, mastoiditis, acute otitis media, and complicated otitis media have been reported from multiple countries in which universal immunization has been implemented. Children with comorbid conditions have higher rates of pneumococcal disease and increased case fatality rates compared with otherwise healthy children, and protection for the most vulnerable pediatric patients will require new strategies to address the underlying host susceptibility and the expanded spectrum of serotypes observed.
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Cohen R, Varon E, Béchet S, Bonacorsi S, Levy C. Comparative impact of pneumococcal conjugate vaccines on pneumococcal meningitis according to underlying conditions. Vaccine 2016; 34:4850-4856. [PMID: 27595445 DOI: 10.1016/j.vaccine.2016.08.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several underlying conditions increase the risk of pneumococcal meningitis (PM) in childhood. Patients with these diseases are initially considered as an important target of pneumococcal conjugate vaccines (PCVs). Limited data are available for PM in children with underlying conditions. To understand the benefits of PCV7 followed by PCV13 in this vulnerable population, we analyzed the data for a large cohort of pediatric patients with PM in France from 2001 to 2014. METHODS We conducted hospital-based active surveillance with 227 pediatric wards working with 168 microbiology departments throughout France. Standardized inclusion criteria for PM were used and data were analyzed by a pre-PCV7, post-PCV7 and post-PCV13 period. RESULTS From 2001 to 2014, among the 1582 cases of PM, 62.5% were reported in children less than 2years old. Underlying conditions (n=255, 16.1%) accounted for 7.3% of the cases in these young children versus 30.8% for children ⩾2-18years old (p<0.001). After PCV13 implementation, PM cases decreased by 44.0% from 2009 to 2014, mainly in children without underlying conditions. Though the number of children with underlying conditions remained stable, their proportion among overall PM cases increased by 79.1%. Among children with underlying conditions, PCV7 serotypes, 6 additional PCV13 serotypes, additional 11 serotypes in PPV23 and other serotypes accounted for 24.5%, 14.7%, 25.0% and 35.8%, respectively (p<0.001). After PCV13 implementation, 50.0% of PM cases with underlying conditions and 37.9% without underlying conditions were caused by serotypes included in neither PCV13 nor PPV23. CONCLUSION Besides the reduced numbers of PM, its profile has changed, with an increase in cases in proportion of children with underlying conditions accompanied by a striking change in serotype distribution. This underlines the importance of detecting underlying conditions in children with PM in the PCV13 era.
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Affiliation(s)
- Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; GPIP, Pediatric Infectious Disease Group, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, France.
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hopital Européen Georges-Pompidou, Paris, France
| | - Stéphane Béchet
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France
| | - Stéphane Bonacorsi
- Univ Paris Diderot, Sorbonne Paris Cité, France; Service de Microbiologie, Hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - Corinne Levy
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; GPIP, Pediatric Infectious Disease Group, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.
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38
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Abstract
The incidence and likely causes of fever of unknown origin (FUO) have changed over the last few decades, largely because enhanced capabilities of laboratory testing and imaging have helped confirm earlier diagnoses. History and examination are still of paramount importance for cryptogenic infections. Adolescents who have persisting nonspecific complaints of fatigue sometimes are referred to Pediatric Infectious Diseases consultants for FUO because the problem began with an acute febrile illness or measured temperatures are misidentified as "fevers". A thorough history that reveals myriad symptoms when juxtaposed against normal findings on examination and simple laboratory testing can suggest a diagnosis of "fatigue of deconditioning". "Treatment" is forced return to school, and reconditioning. The management of patients with acute onset of fever without an obvious source or focus of infection is dependent on age. Infants under one month of age are at risk for serious and rapidly progressive bacterial and viral infections, and yet initially can have fever without other observable abnormalities. Urgent investigation and pre-emptive therapies usually are prudent. By two months of age, clinical judgment best guides management. Between one and two months of age, a decision to investigate or not depends on considerations of the height and duration of fever, the patient's observable behavior/interaction, knowledge of concurrent family illnesses, and likelihood of close observation and follow up. Children 6 months-36 months of age with acute onset of fever who appear well and have no observable focus of infection can be evaluated clinically, without laboratory investigation or antibiotic therapy, unless risk factors elevate the likelihood of urinary tract infection.
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Hon KL, Tsang YCK, Chan LCN, Ng DKK, Miu TY, Chan JY, Lee A, Leung TF. A community-based cross-sectional immunisation survey in parents of primary school students. NPJ Prim Care Respir Med 2016; 26:16011. [PMID: 27053378 PMCID: PMC4823920 DOI: 10.1038/npjpcrm.2016.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/12/2016] [Accepted: 01/26/2016] [Indexed: 11/11/2022] Open
Abstract
Immunisation is a very important aspect of child health. Invasive pneumococcal and influenza diseases have been major vaccine-available communicable diseases. We surveyed demographics and attitudes of parents of primary school students who received pneumococcal conjugate vaccination (PCV) and compared them with those who did not receive pneumococcal vaccination. The survey was carried out in randomly selected primary schools in Hong Kong. Questionnaires were sent to nine primary schools between June and September 2014. Parents of 3,485 children were surveyed, and 3,479 (1,452 PCV immunised, 2,027 un-immunised) valid questionnaires were obtained. Demographic data were generally different between the two groups. PCV-immunised children were more likely to be female (57.0 vs. 52.2%, P=0.005), born in Hong Kong (94.2 vs. 92.3%, P=0.031), have a parent with tertiary education (49.2 vs. 31.8, P<0.0005), from the higher-income group (P=0.005), have suffered upper respiratory infections, pneumonia, otitis media or sinusitis (P=0.019), and have doctor visits in preceding 12 months (P=0.009). They were more likely to have received additional immunisations outside the Hong Kong Childhood Immunization Programme (64.0 vs. 30.6%, P<0.0005) at private practitioner clinics (91.1 vs. 83.5%, P<0.0005). Un-immunised children were more likely to live with senior relatives who had not received PCV. Their parents were less likely to be aware of public education programme on PCV and influenza immunisation, and children were less likely to have received influenza vaccination. The major reasons for PCV immunisations were parent awareness that pneumococcal disease could be severe and vaccines were efficacious in prevention. The major reasons for children not being immunised with PCV were concerns about vaccine side effects, cost, vaccine not efficacious or no recommendation by family doctor or government. In conclusion, PCV unimmunized children were prevalent during the study period. Reportedly, they were generally less likely to have received influenza and other childhood vaccines, and more likely to live with senior relatives who had not received PCV and influenza. These observations provide important demographic data for public health policy in childhood immunisation programme.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Society of Paediatric Respirology and Allergy, Hong Kong
| | - Yin Ching K Tsang
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lawrence C N Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daniel K K Ng
- Hong Kong Society of Paediatric Respirology and Allergy, Hong Kong.,Department of Paediatrics, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Ting Yat Miu
- Hong Kong Society of Paediatric Respirology and Allergy, Hong Kong
| | - Johnny Y Chan
- Hong Kong Society of Paediatric Respirology and Allergy, Hong Kong.,Department of Paediatrics, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Albert Lee
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Society of Paediatric Respirology and Allergy, Hong Kong
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Effectiveness of Pneumococcal Conjugate Vaccines of Different Valences Against Invasive Pneumococcal Disease Among Children in Taiwan: A Nationwide Study. Pediatr Infect Dis J 2016; 35:e124-33. [PMID: 26974752 DOI: 10.1097/inf.0000000000001054] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For the scarcity of data, we investigated the vaccine effectiveness (VE) of the combined use of pneumococcal conjugate vaccines (PCVs) of different valences against invasive pneumococcal disease (IPD) in children. METHODS We conducted a matched case-control study using the national IPD surveillance database and the national vaccination registry. Four age-matched, gender-matched and neighborhood-matched controls were identified for each incident IPD case ≦5 years with disease onsets between October 2007 and December 2013. Conditional logistic regression was used to assess VE against all serotype and serotype 19A IPD. RESULTS In 523 cases (median age: 28.5 months; range: 2.0-69.4 months) and 2086 controls (28.7; 2.2-70.1), a similar VE against all-serotype IPD was found between PCV13 (76%; 61-85%) and combined 7-valent PCV (PCV7)/10-valent PCV (PCV10) plus PCV13 (78%; 56-89%). The VE for PCV7/PCV10 was slightly lower (48%; 32-60%). Regarding serotype 19A, a significantly reduced risk was observed for both PCV13 (82%; 63-91%) and combined PCV7/PCV10 plus PCV13 (87%; 61-96%). PCV7/PCV10 had only a borderline protective association (31%; 4-51%). For children receiving PCV13 alone, VE against all-serotype IPD did not differ between starting the dosing at ≥2 (78%; 56-89%) or <2 (74%; 51-87%) years of age. VE was 81% (69-88%) within 6 months of the last dose of PCV and 19% (95% CI: -21 to 45%) after 2 years. CONCLUSIONS PCVs are effective against IPD during immunization with either the same or with a mixed series, but protection might be differential over time.
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Capsular Polysaccharide (CPS) Release by Serotype 3 Pneumococcal Strains Reduces the Protective Effect of Anti-Type 3 CPS Antibodies. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 23:162-7. [PMID: 26677201 DOI: 10.1128/cvi.00591-15] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/09/2015] [Indexed: 01/01/2023]
Abstract
The efficacy of the serotype 3 (ST3) pneumococcal conjugate vaccine (PCV) remains unclear. While the synthesis of capsular polysaccharide (CPS) of most serotypes is wzy dependent, the strains of two serotypes, 3 and 37, synthesize CPS by the synthase-dependent pathway, resulting in a polysaccharide that is not covalently linked to peptidoglycan and can be released during growth. We hypothesized that the release of CPS during growth reduces anti-type 3 CPS antibody-mediated protection and may explain the lower efficacy of the type 3 component of PCV than that of other PCVs. The in vitro-released CPS concentrations per 10(7) CFU of ST3 and ST37 strains were significantly higher than those for the ST1, ST4, ST6B, and ST14 strains. Following intraperitoneal (i.p.) injection in mice, blood concentrations of CPS were significantly higher for the ST3 than for the ST4/5 strains. The opsonophagocytic killing assay (OPKA) titer of anti-type 3 CPS antibody was significantly reduced by type 3 CPS, culture supernatant, or serum from Streptococcus pneumoniae ST3 strain WU2-infected mice. Mice were injected with capsule-specific antibodies and challenged i.p. with or without the addition of sterile culture supernatant containing type-specific CPS. The addition of 0.2 μl of culture supernatant from WU2 inhibited passive protection, whereas 100-fold-more culture supernatant from S. pneumoniae ST4 strain TIGR4 was required for the inhibition of protection. We conclude that released type 3 CPS interferes with antibody-mediated killing and protection by anti-CPS antibodies. The relative failure of ST3 PCV may be due to CPS release, suggesting that alternative immunization approaches for ST3 may be necessary.
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Pelton SI, Shea KM, Farkouh RA, Strutton DR, Braun S, Jacob C, Klok R, Gruen ES, Weycker D. Rates of pneumonia among children and adults with chronic medical conditions in Germany. BMC Infect Dis 2015; 15:470. [PMID: 26515134 PMCID: PMC4627378 DOI: 10.1186/s12879-015-1162-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this study is to evaluate rates of all-cause pneumonia among “at-risk” and “high-risk” children and adults in Germany—in comparison with age-stratified healthy counterparts—during the period following the 2006 recommendation for universal immunization of infants with pneumococcal conjugate vaccine. Methods Retrospective cohort design and healthcare claims information for 3.4 M persons in Germany (2009–2012) were employed. Study population was stratified by age and risk profile (healthy, “at-risk” [with chronic medical conditions], and “high-risk” [immunocompromised]). At-risk and high-risk conditions, as well as episodes of all-cause pneumonia, were identified via diagnosis, procedure, and drug codes. Results and discussion Rates of all-cause pneumonia were 1.7 (95 % CI 1.7-1.8) to 2.5 (2.4-2.5) times higher among children and adults with at-risk conditions versus healthy counterparts, and 1.8 (1.8-1.9) to 4.1 (4.0-4.2) times higher among children and adults with high-risk conditions. Rates of all-cause pneumonia among at-risk persons increased in a graded and monotonic fashion with increasing numbers of conditions (i.e., risk stacking). Conclusions An increased risk for all-cause pneumonia in German children and adults with a spectrum of medical conditions persists in the era of widespread pneumococcal vaccination, and pneumonia risk in persons with ≥2 at-risk conditions is comparable or higher than those with high-risk conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1162-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen I Pelton
- Boston University School of Public Health, Boston, MA, USA. .,Boston Medical Center, Boston, MA, USA. .,Maxwell Finland Laboratory for Infectious Diseases, 670 Albany Street, 6th Floor, Boston, MA, 02118, USA.
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Hofstetter AM, LaRussa P, Rosenthal SL. Vaccination of adolescents with chronic medical conditions: Special considerations and strategies for enhancing uptake. Hum Vaccin Immunother 2015; 11:2571-81. [PMID: 26212313 PMCID: PMC4685675 DOI: 10.1080/21645515.2015.1067350] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/04/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022] Open
Abstract
Adolescents with chronic medical conditions (CMCs), a growing population worldwide, possess a wide array of preventive health care needs. Vaccination is strongly recommended for the vast majority of these adolescents given their increased risk of vaccine preventable infection and associated complications. Not only should they receive routine vaccines, but some also require additional vaccines. Despite these guidelines, evidence suggests that adolescents with CMCs often fail to receive needed vaccines. Many factors contribute to this under-immunization, including lack of knowledge among parents and providers and suboptimal coordination of primary and subspecialty care. This review describes current vaccination recommendations for these adolescents as well as recent data related to infection risk, vaccine efficacy and safety, vaccination coverage, and the unique multilevel factors impacting uptake in this population. It also discusses strategies for improving coverage levels and reducing missed vaccination opportunities, with a particular focus on technology-based interventions.
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Affiliation(s)
- Annika M Hofstetter
- Department of Pediatrics; University of Washington; Seattle, WA USA
- Center for Clinical and Translational Research; Seattle Children's Research Institute; Seattle, WA USA
| | - Philip LaRussa
- Department of Pediatrics; Columbia University Medical Center; New York, NY USA
- NewYork-Presbyterian Hospital; New York, NY USA
| | - Susan L Rosenthal
- Department of Pediatrics; Columbia University Medical Center; New York, NY USA
- NewYork-Presbyterian Hospital; New York, NY USA
- Department of Psychiatry; Columbia University Medical Center; New York, NY USA
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